Salivary transforming growth factor beta in oral submucous fibrosis: A diagnostic and predictive marker

CONTEXT

Growth factors and cytokines like transforming growth factor beta (TGF-β) play a key role in the pathogenesis of oral submucous fibrosis.

AIMS

To elucidate the role of Salivary TGF-β isoforms as a predictive and diagnostic marker for oral submucous fibrosis.

SETTINGS AND DESIGN

A total of 30 OSMF and 10 control patients were included in this study, and their clinic-epidemiological data was recorded.

METHODOLOGY

The expression of TGF-β genes-TGF-β1, TGF-β2, TGF-β3-was studied by a real-time polymerase chain reaction in tissue and saliva. Patients were given medicinal intervention for 12 weeks along with jaw-opening exercises. Expression of salivary TGF-β genes was studied at 12 weeks.

STATISTICAL ANALYSIS USED

SPSS software version 20.

RESULT

Expression of salivary TGF beta isoforms in OSMF was more than in the control group. There was an increase in salivary TGF-β1, β2, β3 expressions with increasing clinical grades of OSMF and advancing the stage of the disease. Expression of all the TGF beta isoforms was decreased after treatment with statistically significant results. Statistically significant correlations were found between the mean difference of TGF-β1 and the mean difference between mouth opening and tongue protrusion.

CONCLUSION

Salivary TGF-β isoforms may be used in diagnosis, risk assessment, and screening of the entire population at risk of OSMF after its clinical validation. However, adequate sample size and segmental assessment of the expression of TGF-β isoforms are needed for further evaluation.

Guideline for the Diagnosis and Clinical Management of Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a chronic, progressive and potentially malignant oral mucosal disease. Patients often have a habit of chewing betel nuts. Areca catechu has been listed as a Class 1 carcinogen by the International Agency for Research on Cancer (IARC), and its main active component, arecoline, is classified as a Group 2B carcinogen by the IARC. The World Health Organization (WHO) categorises OSF as an oral potentially malignant disorder (OPMD). The present guideline describes the risk factors, clinical symptoms and clinical signs of OSF. Clinical staging, auxiliary examination methods, basis for diagnosis and differential diagnosis and the need to improve bad lifestyle habits are proposed and addressed, and local treatment drugs, therapies, dosage and course of treatment, possible adverse reactions, and oral treatment drugs, dosage and course of treatment are proposed. The guideline also addresses the indications for surgical treatment, alternative non-drug treatment methods, selection of treatment plans for different clinical stages, criteria for efficacy evaluation, and preventive measures.

Saliva based non invasive screening of Oral Submucous Fibrosis using ATR-FTIR spectroscopy

Oral Submucous Fibrosis (OSMF) is a type of precancerous condition of Oral cancer and considered to have the greatest malignant potential. Biopsy is an ultimate option for the conformation of the malignancy. But the invasiveness of the procedure makes it interdict. Therefore, there is an urgent need to identify effective screening and diagnostic methods which would be less invasive, rapid, more accurate and cost effective. Here, we used Attenuated Total Reflection- Fourier transform infrared spectroscopy (ATR-FTIR) with Chemometric analysis coupled with estimation of total salivary protein to discriminate OSMF and Healthy Control (HC). The present study showed the specific Infrared spectrum for OSMF patients, which was specifically differentiated from HC based on the spectral shift of proteins/amide II, carbohydrate and nucleic acid using Principal Component Analysis (PCA) and Hierarchical Clustering Analysis (HCA) with small data sets. ATR-FTIR spectroscopy of saliva coupled with total protein estimation can be used to discriminate between OSMF and HC. However, large sample size should be needed to evaluate the ATR-FTIR for consideration as a screening tool for an early diagnosis OSMF.

Oral submucous fibrosis in children: an alarming condition and challenges in management

Oral submucous fibrosis (OSF) is a well-documented potentially malignant condition. It affects most commonly the adult patients of India and Indian subcontinent, only few cases affecting children have been reported in the literature. This paper presents three cases of OSF below the age of 12 years and reviews the aetiology, clinical presentation, treatment modalities in children with improved follow-up results. Clinical features like restricted mouth opening, burning sensation and history of betel nut chewing helps in the diagnosis of the patients, which can be confirmed by histopathological examination. Conservative management and oral physiotherapy in children help in improved mouth opening. Counselling the children, their friends and parents also plays a vital role. The present paper highlights that children on a larger scale are using tobacco products and further studies are required with larger sample size.

Estimation of serum beta-carotene level in patients suffering from oral submucous fibrosis

INTRODUCTION

Oral submucous fibrosis (OSMF), an insidious disease, has not been widely studied with respect to levels of serum beta-carotene (b-carotene). Hence present study aimed to estimate level of serum beta carotene in patients with OSMF.

MATERIAL AND METHODS

40 subjects (study subjects) with different grades of OSMF and 40 apparently healthy subjects without OSMF (control subjects with age and sex matched as that of study subjects) were screened for serum b-carotene levels employing Sobel and Snow's method. Subjects in both the groups had areca nut or gutkha chewing habit.

RESULTS

Study subjects with OSMF showed lower levels of serum b-carotene as compared to control group subjects without OSMF. When the levels were compared between different disease stages, least levels of serum b-carotene were seen in Grade III OSMF subjects, as compared with Grade I and II subjects. Females showed higher levels of serum b-carotene than males in both the groups. Smokers showed depleted levels as compared to non-smokers in both groups.

CONCLUSION

b-carotene plays an important role in the pathogenesis of OSMF, and its level decreases with disease progression.

Serum-based diagnostic prediction of oral submucous fibrosis using FTIR spectrometry

Oral submucous fibrosis (OSF) is found to have the highest malignant potentiality among all other pre-cancerous lesions. However, its detection prior to tissue biopsy can be challenging in clinics. Moreover, biopsy examination is invasive and painful. Hence, there is an urgent need of new technology that facilitates accurate diagnostic prediction of OSF prior to biopsy. Here, we used FTIR spectroscopy coupled with chemometric techniques to distinguish the serum metabolic signatures of OSF patients (n=30) and healthy controls (n=30). Serum biochemical analyses have been performed to further support the FTIR findings. Absorbance intensities of 45 infrared wavenumbers differed significantly between OSF and normal serum FTIR spectra representing alterations in carbohydrates, proteins, lipids and nucleic acids. Nineteen prominent significant wavenumbers (P≤0.001) at 1020, 1025, 1035, 1039, 1045, 1078, 1055, 1100, 1117, 1122, 1151, 1169, 1243, 1313, 1398, 1453, 1544, 1650 and 1725cm^-1 provided excellent segregation of OSF spectra from normal using multivariate statistical techniques. These findings provided essential information on the metabolic features of blood serum of OSF patients and established that FTIR spectroscopy coupled with chemometric analysis can be potentially useful in the rapid and accurate preoperative screening/diagnosis of OSF.

Qualitative analysis of the impact of Oral Potentially Malignant Disorders on daily life activities

Objective

To evaluate the impact of Oral Potentially Malignant Disorders (OPMD) on daily life activities.

Materials and methods

Patients diagnosed with Oral Leukoplakia, Oral submucous fibrosis and Oral Lichen Planus attending the Oral Medicine clinic of Panineeya Institute of Dental Sciences & Research Centre, Hyderabad, India were invited to participate. Eighteen interviews and three focus groups were conducted in a non-clinical setting. Voice recordings were transcribed and translated from Telugu to English. Data coding was performed using the NVivo software.

Results

Sample size for this qualitative study comprised 32 patients. Four main themes emerged: (1) difficulties with diagnosis and knowledge about the condition, (2) physical impairment and functional limitations, (3) psychological and social wellbeing and (4) effects of treatment on daily life. In a majority of the patients, most of the interview time was spent discussing physical impairment and functional limitations. Patients also reported their mouth condition having a debilitating effect on their psychological well-being and social interactions.

Conclusions

‘Physical impairment and functional limitations’ was the most important theme for many of the patients. However, the impacts of OPMD also extended beyond physical impairment and functional limitations to aspects of daily living, notably psychological and social wellbeing.

Mouth Cancer for Clinicians Part 6: Potentially Malignant Disorders

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team, in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

CLINICAL RELEVANCE

This article offers the dental team an overview of oral potentially malignant disorders.

Fibroblast Growth Factor (FGF-2) and Its Receptors FGFR-2 and FGFR-3 May Be Putative Biomarkers of Malignant Transformation of Potentially Malignant Oral Lesions into Oral Squamous Cell Carcinoma

There are several factors like angiogenesis, lymphangiogenesis, genetic alterations, mutational factors that are involved in malignant transformation of potentially malignant oral lesions (PMOLs) to oral squamous cell carcinoma (OSCC). Fibroblast growth factor-2 (FGF-2) is one of the prototypes of the large family of growth factors that bind heparin. FGF-2 induces angiogenesis and its receptors may play a role in synthesis of collagen. FGFs are involved in transmission of signals between the epithelium and connective tissue, and influence growth and differentiation of a wide variety of tissue including epithelia. The present study was undertaken to analyze expression of FGF-2 and its receptors FGFR-2 and FGFR-3 in 72 PMOLs, 108 OSCC and 52 healthy controls, and their role in risk assessment for malignant transformation of Leukoplakia (LKP) and Oral submucous fibrosis (OSMF) to OSCC. Immunohistochemistry was performed using antibodies against FGF-2, FGFR-2 and FGFR-3. IHC results were validated by Real Time PCR. Expression of FGF-2, FGFR-2 and FGFR-3 was upregulated from PMOLs to OSCC. While 90% (9/10) of PMOLs which showed malignant transformation (transformed) expressed FGF-2, only 24.19% cases (15/62) of PMOLs which were not transformed (untransformed) to OSCC expressed FGF-2. Similarly, FGFR-2 expression was seen in 16/62 (25.81%) of untransformed PMOLs and 8/10 (80%) cases of transformed PMOLs. FGFR-3 expression was observed in 23/62 (37.10%) cases of untransformed PMOLs and 6/10 (60%) cases of transformed PMOLs. A significant association of FGF-2 and FGFR-2 expression with malignant transformation from PMOLs to OSCC was observed both at phenotypic and molecular level. The results suggest that FGF-2 and FGFR-2 may be useful as biomarkers of malignant transformation in patients with OSMF and LKP.

Can quantifying free-circulating DNA be a diagnostic and prognostic marker in oral epithelial dysplasia and oral squamous cell carcinoma?

PURPOSE

Previous studies have reported significantly higher concentrations of serum DNA in various types of cancers. Thus the study aims to determine whether circulating free DNA (CFDNA) can aid in the diagnosis and prognosis of oral epithelial dysplasia and oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

A nonrandomized case-control study was planned where cases were derived from patients who presented to the KLE Institute of Dental Sciences, Belgaum, India, for evaluation and management of oral lesions between 2007 and 2009. In this study the predictor variable was status of the disease in the patients, and the outcome variable was CFDNA. Demographic variables included age, gender, tobacco consumption, and stage at diagnosis of cancer. Subjects with any known systemic disease, other tumors, or metastatic OSCC were excluded (CFDNA is altered in cases of tissue destruction and inflammatory diseases). The amount of CFDNA was determined through spectrophotometry (NanoDrop ND-1000 spectrophotometer; Thermo Fisher Scientific, Waltham, MA) in sampled blood and plasma. Mean and range for DNA quantification in plasma and blood were calculated in all groups and compared by use of the analysis of variance test.

RESULTS

A total of 390 cases (90 potentially malignant lesions, 150 OSCC cases, and 150 post-treatment OSCC cases) and 150 control subjects were studied. No significant difference was observed in levels of CFDNA in blood between the groups. Similarly, levels of CFDNA in plasma showed no significant difference except between the OSCC and potentially malignant groups, which was probably artifactual.

CONCLUSIONS

This study shows that disease progression in oral malignancy does not correlate with changes in levels of CFDNA in blood or plasma.

Areca nut in pathogenesis of oral submucous fibrosis: revisited

BACKGROUND

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oropharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. It is considered as a pre-malignant stage of oral cancer, and the reported risk of malignant transformation varies from 2.3-7.6%.

CONCLUSIONS

The common etiological factor considered for this unremitting disease is use of areca nut; however, the precise mechanism still remains elusive and controversial. A wide range of treatment consisting of drugs, surgical therapy, and physiotherapy have been attempted till date, with varying degrees of benefit, but none of them have proved to be a cure for this disease. This field remains open for clinical trials and research. This paper aims to give an overview on the role of areca nut in the pathogenesis and malignant potential of oral submucous fibrosis.

Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians

INTRODUCTION

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. There are only few studies on the frequency and clinicopathological feature of oral submucous fibrosis in the Indian population in recent years.

MATERIAL AND METHODS

The present study evaluated 205 cases of oral submucous fibrosis for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, malignant potential, and the histopathology.

RESULTS AND DISCUSSION

Oral submucous fibrosis was seen in younger age (20-30 years) than that reported in literature and showed a characteristic male preponderance. A strong association with smokeless tobacco use especially arecanut in the form of gutkha was established and was related to earlier development of oral submucous fibrosis (OSMF), i.e., within a year of the habit. A total of 11.6% of cases were associated with malignancy and occurred predominantly in males.

CONCLUSION

This article gives an insight into OSMF in this part of southern India and adds to its biologic profile.

Improved diagnosis of oral premalignant lesions in submucous fibrosis patients with 5-aminolevulinic acid induced PpIX fluorescence

We investigate the possibility of using ALA-derived PpIX fluorescence spectroscopy for the detection of epithelial hyperkeratosis (EH) or epithelial dysplasia (ED) lesions in oral submucous fibrosis (OSF) patients that could not be found by autofluorescence spectroscopy. Twenty percent of ALA solution gel was applied onto oral neoplasia and surrounding normal tissue [normal oral mucosa (NOM)] for 90 min. Fluorescence emission spectra were measured under 410 nm excitation. Generally, the most intense fluorescence emission peaks occurred at 460 and 630 nm. The ratios of the area under red peak (630+/-10 nm) to the area under blue peak (460+/-10 nm), denoted as RB, were calculated. We found that OSF mucosa has the lowest RB value, followed by NOM, EH on OSF, and ED on OSF. An ANOVA test showed significant differences between OSF, NOM, EH on OSF, and ED on OSF (p<0.05). However, measurements of autofluorescence (i.e., before ALA application) show no significant differences between OSF, NOM, EH on OSF, and ED on OSF (ANOVA test, p>0.05). These results indicate that ALA-induced PpIX fluorescence spectroscopy could be used to identify the premalignant lesions on oral fibrotic mucosa, which could not be found by autofluorescence.

A novel wavelet neural network based pathological stage detection technique for an oral precancerous condition

AIM

To describe a novel neural network based oral precancer (oral submucous fibrosis; OSF) stage detection method.

METHOD

The wavelet coefficients of transmission electron microscopy images of collagen fibres from normal oral submucosa and OSF tissues were used to choose the feature vector which, in turn, was used to train the artificial neural network.

RESULTS

The trained network was able to classify normal and oral precancer stages (less advanced and advanced) after obtaining the image as an input.

CONCLUSIONS

The results obtained from this proposed technique were promising and suggest that with further optimisation this method could be used to detect and stage OSF, and could be adapted for other conditions.

Clinical significance of total and lipid bound sialic acid levels in oral pre-cancerous conditions and oral cancer

BACKGROUND

Altered glycosylation of glycoconjugates is among the important molecular changes that accompany malignant transformation. The purpose of our study was to investigate clinical usefulness of circulatory levels of total and lipid bound sialic acid for early diagnosis and management of oral cavity cancer patients.

METHODS

Blood samples were collected from 41 untreated oral cancer patients, 20 patients with oral pre-cancerous conditions (OPC) and 20 healthy subjects. Serum sialic acid (total and lipid bound) levels were measured spectrophotometrically.

RESULTS

Serum levels of total and lipid bound sialic acid were significantly elevated (P < 0.001) in untreated oral cancer patients as compared to healthy individuals as well as patients with OPC. Multivariate analysis documented that the progressive rise in total and lipid bound sialic acid was significantly associated (P = 0.0001 and 0.039, respectively) with stage of malignant disease.

CONCLUSION

The data revealed significant elevations in sialic acid levels in oral cancer patients and suggested potential utility of these parameters in diagnosis as well as determining clinical stage of the malignant disease.

A scoring system for the early detection of oral submucous fibrosis based on a self-administered questionnaire

OBJECTIVES

The aims of the present study were to evaluate the frequent clinical complaints of oral submucous fibrosis (OSF) and to develop a scoring system for early detection of the disease by a self-administered questionnaire.

METHODS

A total of 296 subjects were recruited, including 123 OSF patients without oral cancer and 173 betel quid chewers without OSF or oral cancer. A self-administered questionnaire was used to collect the symptom profile from study subjects. Their maximal mouth opening (MMO) between upper and lower incisor edges was measured and recorded by well-trained nurses. A binary logistic regression model examining the likelihood of OSF based on the eight symptoms of interest was used to develop the scoring system.

RESULTS

Among 79 OSF subjects with an MMO < 35 mm, the most frequent complaint was trismus (87.3%), followed by burning sensation (76.0%) and xerostomia (72.2%). Among 44 OSF subjects with an MMO > or = 35 mm, burning sensation (68.2%) was the most frequent complaint, followed by trismus (54.5%) and xerostomia (54.5%). Six frequent complaints including trismus, burning sensation, xerostomia, sore throat, numbness, and oral ulceration were utilized to develop a scoring system for the early detection of OSF. The scoring system had an area under the receiver operating characteristic curve of 0.90.

CONCLUSION

This study suggests a screening questionnaire of frequent complaints for the early detection of OSF.

Auto-fluorescence spectra of oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic oral mucosal disease characterized by progressive deposition of collagen in the subepithelial connective tissue and epithelial atrophy. Previous studies have shown that at 330-nm excitation, the 380- and 460-nm emission peaks of the auto-fluorescence spectra for oral mucosal tissues reflect the collagen content in the subepithelial connective tissue and the nicotinamide adenine dinucleotide phosphate (NADH) content in the epithelial cells, respectively. Therefore, at 330-nm excitation OSF mucosa may have a higher 380-nm emission peak and a lower 460-nm emission peak than the normal oral mucosa (NOM).

METHODS

To test the above hypothesis, we measured the in vivo auto-fluorescence spectra of 59 OSF mucosal sites and compared the measured spectra with auto-fluorescence spectra obtained from 15 NOM samples from 15 healthy volunteers, five samples of friction hyperkeratosis (histologic diagnosis, hyperkeratosis and acanthosis) on OSF buccal mucosa (FHOSF), and 29 samples of oral leukoplakia (histologic diagnosis, hyperkeratosis and acanthosis) on OSF buccal mucosa (OLOSF).

RESULTS

We found that the spectrum of the OSF mucosa had a significantly higher 380-nm emission peak and a significantly lower 460-nm emission peak than the spectra of NOM, FHOSF, and OLOSF samples. When the mean (+/-SD) fluorescence intensities at 380 +/- 15 nm (I380 +/- 15 nm) and 460 +/- 15 nm (I460 +/- 15 nm) emission peaks and the mean ratio of I460 +/- 15 nm/I380 +/- 15 nm were compared between groups, we found that OSF group had a significantly higher mean value of I380 +/- 15 nm, a significantly lower mean value of I460 +/- 15 nm, and a significantly lower mean ratio of I460 +/- 15 nm/I380 +/- 15 nm than the NOM, FHOSF, and OLOSF groups (P < 0.001). However, no significant differences in the mean values of I380 +/- 15 nm, I460 +/- 15 nm, and ratio of I460 +/- 15 nm/I380 +/- 15 nm were found between NOM and FHOSF or OLOSF samples as well as between FHOSF and OLOSF samples (P > 0.05).

CONCLUSION

Because OSF mucosa has a very unique pattern of auto-fluorescence spectrum, we conclude that auto-fluorescence spectroscopy is a good method for real-time diagnosis of OSF.

Oral lesions and conditions associated with human immunodeficiency virus infection in 300 south Indian patients

BACKGROUND

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a major health problem in India. The National AIDS Control Organisation (NACO) of India reports a seropositivity of 25.03 per thousand for the whole country, as of October 1999. In spite of this high prevalence there are very few reports of oral lesions and conditions in Indian HIV/AIDS patients, which are important in early diagnosis and management of these patients.

OBJECTIVE AND SETTING

The present report describes the oral lesions in 300 HIV positive symptomatic patients presenting to us at RAGAS-YRG CARE, a non-governmental organisation in Chennai, South India, over a period of 9 months in 1998.

METHOD

Lesions were diagnosed on clinical appearance using international criteria.

RESULTS

Of the 300 patients 89% had acquired the infection through heterosexual contact. There were 205 males and 95 females, aged from 7 months to 72 years. Forty-seven percent of the patients were in the age group 21-30 years. CD4 counts were ascertained for 105 patients, 64 (62%) had CD4 counts < or = 200. A total of 217 (72%) of the 300 patients had some oral lesion when examined. Gingivitis (47%) and pseudomembranous candidiasis (33%) were the most common oral lesions. The other oral lesions seen were oral mucosal pigmentation (23%), erythematous candidiasis (14%), periodontitis (9%), angular cheilitis (8%), oral ulcers (3%), oral hairy leukoplakia (3%), hyperplastic candidiasis (1%), oral submucous fibrosis (2%) and one case of leukoplakia.

CONCLUSIONS

Oral lesions occur commonly in HIV infection. A comprehensive oral examination may not only suggest HIV disease but may also be useful in monitoring the disease progression. This is a cost-effective procedure, which may be useful in screening large populations in developing countries like India.

Update on precancerous lesions

Oral cancer continues to be a serious problem in the UK and it is well known that prevention and early recognition of potentially malignant lesions will provide the best prognosis. This article discusses recent changes in the nomenclature of lesions and current concepts in diagnosis and management.

Establishing a normal range for mouth opening: its use in screening for oral submucous fibrosis

The maximal mouth opening of 700 healthy Nepalese adults, age range of 18-68 years, measured by paraclinical workers was determined as there are no data available for an Asian population. The mean value of the inter-incisal distance was 47.1 mm (range 33.7-60.4 mm) and 98% of the population surveyed fell within this range. The minimum limit of normal oral opening was determined to be 34 mm. Ten out of 13 patients with histologically confirmed oral submucous fibrosis (OSF) had a maximal oral opening of less than 34 mm. It was concluded that reduced oral opening measured by paraclinical workers as a single screening test for oral submucous fibrosis, has a sensitivity of only 77% and will detect only advanced cases. However, each of the 3 subjects from the healthy population found to have restricted mandibular opening and who agreed to be examined further had significant oral conditions, namely oral submucous fibrosis (2) and pericoronitis (1). The study confirms the value of this measurement as a screening procedure for significant oral disease by paraclinical staff particularly in developing countries where trained dental and medical personnel are scarce. Because of its limited sensitivity, measurement of mouth opening is unsatisfactory as a single screening test for OSF, as it will not detect early stages of the disease.

Sensitivity and specificity of OraScan (R) toluidine blue mouthrinse in the detection of oral cancer and precancer

The efficacy of 1% toluidine blue in the identification of oral malignancies and potentially malignant oral lesions was evaluated among a group of Asian patients (n = 102) with undiagnosed oral mucosal lesions and conditions (n = 145). The trial, utilising a ready-to-use kit, was controlled by histopathologic evaluation of a total of 87 dye-retained or dye-negative lesions. Eighteen oral carcinomas all retained the dye and there were no false negatives, yielding a test sensitivity of 100%. Eight of 39 oral epithelial dysplasias were toluidine blue-negative, giving a false negative rate of 20.5% and a sensitivity of 79.5% for oral epithelial dysplasias. The specificity of the technique was low (62%). Five dysplastic lesions were detected solely by the kit and this suggests that the method is valuable for surveillance of high-risk subjects in addition to its remarkable sensitivity in the detection of invasive carcinoma.

Silver-binding nucleolar organizer region proteins as a possible prognostic indicator in oral submucous fibrosis

Silver-binding nucleolar organizer region proteins (AgNORs) were counted in sections from formalin-fixed, paraffin-embedded tissue blocks of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (SCC). Moderately advanced and advanced cases OSMF, and well-differentiated and poorly differentiated cases of SCC, were studied with respect to the relation between AgNOR counts and histologic grading. Normal oral mucosa collected from age- and sex-matched subjects constituted the control group. The pooled mean (+/- SD) AgNOR counts were as follows: normal mucosa, 2.50 +/- 0.52 (n = 5); moderately advanced OSMF, 5.24 +/- 1.23 (n = 10); advanced OSMF, 7.26 +/- 1.12 (n = 10); well-differentiated SCC, 8.29 +/- 1.47 (n = 5); and poorly differentiated SCC, 9.49 +/- 0.74 (n = 5). The pooled mean AgNOR counts in advanced OSMF were higher than in moderately advanced cases (t = 3.84; p < 0.005) and those in poorly differentiated SCC were higher than those of well-differentiated SCC, although the comparison was not significant in the latter (t = 1.63, p > 0.10). AgNOR counts could hold promise for predicting the biologic behavior of OSMF because this study demonstrated a correlation with clinical and histologic grading.

Oesophageal changes in oral submucous fibrosis using fibreoptic endoscopy--a pilot study

Thirty patients with oral submucous fibrosis (OSMF) underwent fibreoptic upper G.I. endoscopy and oesophageal biopsy from 20 cms to see if any correlation is found between visual and histological changes in OSMF and oesophageal mucosa. On endoscopy, the colour of oesophageal mucosa was normal in 28 and whitish pale in 2 cases. On endoscopy mucosa felt stiff and fibrotic in 19, leathery in 4, firm/gritty in 2 and normal in 5 cases. The biopsies were difficult to take in most cases yielding small tissue samples on repeated attempts. On histology most of the samples consisted of only a few layers of hyperplastic epithelium with lamina propria and submucosa being absent in all samples. Good correlation was found between the grade of OSMF and oesophageal changes seen on endoscopy.

Serum copper and zinc levels in premalignant and malignant lesions of the oral cavity

Serum levels of copper and zinc were analysed in 50 patients with oral cancer, 50 patients with oral leucoplakia, and 50 patients with oral submucous fibrosis, and the values were compared with those of 50 normal healthy adult controls. There was a significant reduction in the serum copper and zinc levels in both oral submucous fibrosis and oral cancer. The copper/zinc ratio was found to be elevated in oral submucous fibrosis and depressed in oral cancer. The ratio may serve as a good indicator for the early detection of oral cancer.